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MARION COUNTY BUILDING INSPECTION
<br />SENATOR BLDG. NO. 225
<br />220 HIGH STREET NE
<br /> SALEM, OREGON 97301
<br />
<br /> PHONE: 588-5147 8:00 - 4:30
<br />24 HOUR CODE-A-PHONE: 588-7904
<br />
<br />of a registered buiider,
<br />
<br />Other
<br />
<br />I have read and agree tO the terms stated on the reverse side of
<br />this documenh
<br />
<br />SIGNATURE OF APPLICANT:
<br /> GATE:
<br />
<br />FILE
<br />
<br />OWNE~'. DATE: ~¢9/24/93
<br /> CBM DEVELOPMENT
<br /> SITUS ADDRESS:
<br />
<br />'i-]:ME: &,,
<br />
<br />TAX LOT
<br />
<br />GONSTRUCTION TYPE
<br />
<br />CATEGORY:
<br />
<br /> C Oi'ti~ E Ri:;
<br />
<br /> 1.2094 ENI._E"I,t RD
<br /> AURORA
<br />USE OF BUILDING;
<br />
<br /> NE
<br />OR 97002
<br />
<br />CONTRACT CITY: UGE;
<br /> MARION I. JILJN~ Y NO
<br />
<br />SUBDIVISION;
<br />
<br />OCCUPANT LOAD:
<br />
<br /> NO OF BEDROOM5
<br />
<br />LOT' BLOCK: GECTION TOWNSHIP:
<br />
<br />SITE NUMBER: 93-03185
<br />VALUA'FI[)N:
<br />
<br /> RANGE ZONE MAP.
<br />
<br />4.,52
<br />
<br />u.,T? iJs , LoT cJ&
<br />AC NO NO
<br />
<br />TYPE: 0H-SiTE SEWAGE
<br />
<br />PERHIT OR APPLICATION NO: 70499~6
<br />
<br />COM'f'RA¢I'OR, klO.
<br />C}~il DE VELOM"~I-]fF
<br />;[53;i.:~ EMI,.EN RD NE CONTA[:'I' 3.64-6
<br />AURORA OR 97002 JEFF GALLAGER
<br />P H 0 I, I1.:_': 678-'.1.020
<br />
<br />WATER SUPPLY: I'-"W
<br />'fES'f HOI.,,ES READY: YES
<br />si'rE EYALUATi'ON NUM;(ER:
<br />EXISTING TANK SIZE:
<br />EX:[STIN~ DRAIN FIEL~
<br />SEPTIC 'fANE PUMPED:
<br />PREVIOUS NO. BEDROOMS:
<br />
<br /> ITEM QUANT I TY AMOUNT
<br />IdOLDII,I£; I'ANK 1 $255.00
<br />SZl'E EYAI._,, - F:ERST i000 GAL DSF 1 $265.00
<br />
<br /> TOTAL ASSESSED FEES $520,,08
<br /> PREYDUS RECEIPTS $2.%,, (')0
<br /> TI-grs RECEIPT $265.00
<br />
<br /> BALANCE DUE
<br />,,P,,AYEE:, .- -~u'~,CBM DEVELOPMEN'L--,, RECEIPI' NO: 525;~4
<br />
<br />,~I...L A1 ~AI,,IIED DOCUMEllf"FoR RE~-IU~,RLi4EI'ITS OF ON SITE SEWA(,E
<br />
<br /> NOTE: ...... c .... ~" ' :" ":-
<br /> tH.L:, DOE,-, NOt (;,RAN'f 01:~ I~Pt,.Y PERNISSION TO BU:[LD ON 'f'N;[S FAIJ.,I,I ..... PI,.ANFI:~M~ AhtD
<br />OF[f~'TRUCI'ZON I:.I~M.~S MUST BE OBTAIIqED BEFORE BUZI:LD]:N(; OR SEt::'T~C INE;'f'ALLATIOI'~
<br />
<br /> PLAi~ E/.I.E.~,, BY .......................... DATiE ........................ CITY JbM, SD].(,,F,I, OI~. t~Y DATE
<br />
<br /> i'.~I;:HA~:~I(S~ SE.., I -I. kEADY 9/~5/9;~/N-F
<br />
<br /> OFFICE COPY
<br />FORM # MC 15,56 R~V, 4/90
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